Retired Nurses National Home

Updated 19 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 3 inspectors and a specialist pharmacist.

Service and service type

Retired Nurses National Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Retired Nurses National Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. However, there was a home manager in post, who we will refer to as, ‘the manager’ throughout this report.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and safeguarding teams. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 9 people who used the service and 6 relatives about their experience of the care provided. We spoke with and received feedback from 15 members of staff including the nominated individual, home manager, deputy manager, regional director, chef, and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received feedback from 2 health and social care professionals who work with the home.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included 32 people's care records and 10 people's medicine records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 19 September 2023

About the service

Retired Nurses National Home is a residential care home providing personal care and support for up to 52 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 32 people using the service.

People’s experience of using this service and what we found

People were not always protected from harm and abuse as safeguarding concerns had not been identified by staff and referrals were not always made to the local authority. Staff had received safeguarding training but had not always reported concerns. Some records completed by staff, did not demonstrate dignity and respect were given to people living at the home. Risks people faced were not always assessed robustly enough to support their safety. Risks regarding people’s health conditions were not always mitigated, especially where they could develop into a medical emergency.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The service had not notified the CQC of all incidents that took place within the service as legally required. The provider wrote to us following the last comprehensive inspection to tell us how they would ensure they would meet the regulations. We found that some of these actions and improvements had not been sustained.

Management oversight within the home and at provider level was not robust. This was because their systems had not identified the shortfalls found within the inspection. During and after the inspection the provider had been responsive to address the issues identified and took action to make improvements.

People and their relatives told us they were happy with the care they received from the Retired Nurses National Home. Recruitment processes were in place to ensure staff had the right skills to work with people and various checks were carried out. People were protected from avoidable infections as safe procedures were in place which promoted a safe, hygienic environment. People were able to move safely around the home including to outside spaces.

People had access to healthcare and the home worked well with health and social care professionals. Staff had training for them to carry out their role. People received their medicines as prescribed. People had enough to eat and drink. The home sought feedback on the care it provided, people were consulted through meetings. Staff received training to support them in their role.

Staff felt appreciated and were complimentary about their colleagues. We received positive feedback about the management of the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 26 January 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two rated consecutive inspections.

Why we inspected

We received concerns in relation to safeguarding people from harm and abuse, safety of medicines and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained as requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Retired Nurses National Home on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to safeguarding people from harm and abuse, consent, safe care and treatment and the management of the home.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.